Historically the two professions grew out of similar roots, but they have evolved to the point where their similarities are to be seen only in the relatively narrow areas of pain and dysfunction in the back and neck. Their differences become very apparent in their consideration of general health care.

Manipulative Therapy
This has grown out of the tradition of remedial massage and bonesetting. Whilst utilizing techniques which resemble osteopathic manipulative therapy and chiropractic, manipulative therapists regard their work as being aimed at the physical normalization of joint and muscle dysfunction, with the objective of improving mechanical function. No attempt is made to relate the methods to broader aspects of body function or ill health; indeed such ideas are actively discouraged by the leaders of this profession, which sees itself as a system subsidiary to medicine, in contrast to osteopathy which sees itself as an alternative.

Most of the work of these therapists involves massage, with manipulation only being used when considered absolutely necessary. There are no full time training facilities for such practitioners who are, as a rule, physiotherapists or masseurs drawn to these methods. Some are skillful and competent, but their narrow view as to the value and application of manipulation, together with their limited approach to bodily dysfunction, distinguishes them from the osteopathic practitioner. Bonesetters
There are still some 'bonesetters' about, especially in remote rural areas. These are, frequently, gifted healers carrying on an unwritten tradition of learned and acquired skills which go back into prehistory.

In England, there was for many centuries a tradition of bonesetters. Many of these undoubtedly skilled practitioners had no formal medical training. In the early eighteenth century a Mrs Mapp achieved a great following and was consulted by many doctors.

In 1867 Sir James Paget, an eminent physician, warned his fellow doctors: 'Few of you are likely to practice without having a bonesetter for a rival; and if he can cure a case which you have failed to cure, his fortune will be made and yours marred.'

The fame of Herbert Barker, an unqualified bonesetter, was so great that he was eventually knighted for his services. He was hounded by orthodox medicine and all contact between Barker and doctors was forbidden on pain of expulsion from the profession; this, despite his continual stream of successful cases. In his old age Barker demonstrated his techniques to a group of orthopaedic surgeons in London, a final admission of his genius.

Manipulation, as practiced by bonesetters, was a relatively simple matter of pushing or pulling restricted joints, to achieve ease of movement. Sometimes great force was used and frequently damage was caused by excessive violence. The difference between such methods and their total lack of any coherent or systematic use differentiates them from osteopathy.

Massage
Massage has a long history, but not until the nineteenth century was a systematic approach developed by P. H. Ling in Sweden. A school of medical gymnastics was founded, and this promoted the use of 'scientific' massage. Many variations exist. Some methods are remedial, being aimed at the restoration of function lost during surgery or because of enforced bed-rest (accidents, strokes etc.), or through advancing age. Other methods are used to encourage function in birth injuries or disease-damaged (polio) patients. Massage techniques are also used in gaining general relaxation and circulatory improvements.